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American Academy of Pediatrics
Research Articles

Diagnosis and Management of Bacteremic Urinary Tract Infection in Infants

Heidi K. Roman, Pearl W. Chang and Alan R. Schroeder
Hospital Pediatrics January 2015, 5 (1) 1-8; DOI: https://doi.org/10.1542/hpeds.2014-0051
Heidi K. Roman
1Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California; and
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Pearl W. Chang
2Department of Pediatrics, Lucile Packard Children’s Hospital at Stanford, Palo Alto, California
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Alan R. Schroeder
1Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California; and
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Abstract

Objectives: To report the prevalence of bacteremia by age in a sample of infants <1 year of age with urinary tract infections (UTIs), to compare characteristics of infants with UTIs with and without bacteremia, and to describe treatment courses and 30-day outcomes in infants with UTIs with and without bacteremia.

Methods: We used a retrospective cross-sectional design to determine the prevalence of bacteremia in infants with UTIs at our institution. A double cohort design matching for age and gender was used to compare clinical characteristics and outcomes between infants with bacteremic versus nonbacteremic UTIs.

Results: We identified 1379 UTIs, with blood cultures obtained in 52% of cases. The prevalence of bacteremia was 4.1% (95% confidence interval 3.1%–5.3%) for all UTIs and 8% (95% confidence interval 6.1%–10.2%) for UTIs in which blood culture was obtained. Fifty-five infants with bacteremic UTIs were compared with 110 infants with nonbacteremic UTIs. Except for minor differences in the urinalysis and serum band count, there were no significant differences in clinical presentation between the 2 groups. Bacteremic infants received longer parenteral treatment courses than nonbacteremic infants (mean 6.7 vs 2.4 days, P < .001). Treatment courses in the bacteremic group were variable and predicted by age but not severity of illness. No bacteremic infant had recurrent UTI or bacteremia with the same organism within 30 days of discharge.

Conclusions: Treatment was variable but outcomes were excellent in infants with bacteremic UTIs.

  • urinary tract infection
  • bacteremia
  • serious bacterial infection
  • hospitalization
  • Abbreviations:
    CI
    confidence interval
    cfu/mL
    colony-forming units per milliliter
    CSF
    cerebrospinal fluid
    hpf
    high-powered field
    IV
    intravenous
    LOS
    length of stay
    OR
    odds ratio
    SCVMC
    Santa Clara Valley Medical Center
    UA
    urinalysis
    UTI
    urinary tract infection
    VCUG
    voiding cystourethrogram
    WBC
    white blood cell
    • Copyright © 2015 by the American Academy of Pediatrics
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    Hospital Pediatrics: 5 (1)
    Hospital Pediatrics
    Vol. 5, Issue 1
    1 Jan 2015
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    Diagnosis and Management of Bacteremic Urinary Tract Infection in Infants
    Heidi K. Roman, Pearl W. Chang, Alan R. Schroeder
    Hospital Pediatrics Jan 2015, 5 (1) 1-8; DOI: 10.1542/hpeds.2014-0051

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    Diagnosis and Management of Bacteremic Urinary Tract Infection in Infants
    Heidi K. Roman, Pearl W. Chang, Alan R. Schroeder
    Hospital Pediatrics Jan 2015, 5 (1) 1-8; DOI: 10.1542/hpeds.2014-0051
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    • Considering Cultures and Consequences: The Relevance of Bacteremia in Infant UTIs
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